Jing Wang,1 Xintian Wang,1 Yuyang Li,1 Xin Yao,1 Yuanyuan Shen,1 Ziling Song,1 Peihua Zhang,2 Xiaoqiong Huang2 

1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People’s Republic of China; 2National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People’s Republic of China

Correspondence: Xiaoqiong Huang, Email 13906632387@eye.ac.cn

Purpose: Exploring the mechanisms of fear of negative evaluation (FNE) and self-esteem between family functioning and social avoidance and distress (SAD) to inform the promotion of social functioning in people with strabismus.
Patients and Methods: Convenience sampling was used to select 249 strabismus patients attending a tertiary-level ophthalmology hospital in Wenzhou City from July 2023 to February 2024. The Social Avoidance and Distress Scale, Rosenberg Self-Esteem Scale, Brief Fear of Negative Evaluation Scale, and Family APGAR Index Questionnaire were utilized to assess levels of social avoidance and distress, self-esteem, fear of negative evaluation, and family functioning. Structural equation modeling (SEM) was employed to explore the sequential mediating role of FNE and self-esteem in the relationship between family functioning and SAD.
Results: Family functioning negatively predicted SAD directly (β=− 0.14, P< 0.01). Additionally, family functioning predicted FNE (β=− 0.19, P< 0.01) and self-esteem (β=0.41, P< 0.01). FNE positively predicted SAD (β=− 0.38, P< 0.01) and negatively predicted self-esteem (β=− 0.22, P< 0.01). Moreover, self-esteem negatively predicted SAD (β=− 0.33, P< 0.01). FNE and self-esteem mediated the relationship between family functioning and SAD, with a combined mediating effect of − 0.249, explaining 63.52% of the total variance.
Conclusion: This study examined how FNE and self-esteem affect the link between family functioning and SAD in patients with strabismus. These findings complement our understanding of SAD mechanisms in strabismus patients, encompassing familial, cognitive, and emotional perspectives, and offer theoretical insights for enhancing social functioning in this population.

Keywords: strabismus, social avoidance and distress, family functioning, fear of negative evaluation, self-esteem, chain mediation